Provider Demographics
NPI:1306292750
Name:MALLOY, MELISSA (RDN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MALLOY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 27TH ST
Mailing Address - Street 2:2A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2434 27TH ST
Practice Address - Street 2:2A
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2473
Practice Address - Country:US
Practice Address - Phone:347-834-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered